PER MR.B.S.WASEKAR, HON’BLE PRESIDENT

1)                The present complaint has been filed by the complainant under section 12 of the Consumer Protection Act, 1986. According to the complainant, her husband Shri Ramchandra Shivram Dimble was an agriculturist holding agricultural land Gut No.558 at village-Kalyan, Taluka-Haweli, District-Pune. He died accidentally on 10^th August, 2012 in motor vehicle accident. She submitted insurance claim under the Government Scheme of Shetkari Apghat Vima Yojana.  Her claim was not satisfied therefore she has filed this complaint for insurance claim of Rs.1 Lakh with interest.

2)                The O.P.No.1 appeared and filed written statement. It is submitted that the claim was rejected vide letter dated 19^th December, 2012 as complete set of documents was not submitted within time as per Tripartite Agreement therefore, she can not file claim before this Forum. There is no deficiency in service on the part of the opponent therefore the complaint is liable to be dismissed with cost.

3)                The O.P.No.2 appeared and filed written statement and submitted that claim was received through District Agricultural Officer, Pune and the same was forwarded to the O.P.No.1 and the O.P.No.1 repudiated the claim vide letter dated 19^th December, 2012.

4)                After hearing all the parties and after going through the record, following points arise for our consideration.

POINTS

REASONS

5) As to Point No.1 & 2 :- The complainant has produced revenue record showing that her husband was holding agricultural land and he was farmer. The complainant also produced copies of Preliminary Enquiry Police Report, Police Complaint, Spot Panchanama, Inquest Panchanama, Accidental Death Report, Hospital Discharge Report and copy of Claim Form submitted to the Talathi. On going through all these papers, it is clear that the husband of the complainant died in the motor vehicle accident. According to the opponents, complete set of documents was not submitted. On perusal of the documents produced by the complainant, it is complete set as per requirement under the Agreement.  Under the Government Resolution, the beneficiary has to submit the claim to the concern agricultural department and the concern agricultural department has to comply all the formalities i.e. necessary documents and submit it to the opponents.  Liability is fixed on the government agricultural department.  The beneficiary should not be suffered due to lack of the compliance within time by the government machinery. According to the complainant, the claim was submitted to the opponent government office within time.  The opponents had produced copy of repudiation letter dated 19^th December, 2012. If, according to the opponents, complete set of documents was not submitted within time, it was necessary to inform the complainant accordingly.  There is nothing on record to show that the complainant was informed to submit the complete set of documents. On the other hand, the complainant has submitted copy of Claim Form submitted to the Talathi, Kalyan.  Therefore, the defence taken by the opponents can not be accepted. The complainant has produced all the required documents under the Agreement therefore her claim can not be rejected. 

6)                The O.P.No.2 has placed reliance on the judgment of our State Commission in First Appeal No.1114 of 2008 dated 16^th March, 2009.  In that judgment, Tahsildar failed to produce the documents in spite of service of notices for several times.  In the instant complaint before us, there is no evidence to show that the complainant was intimated to produce the documents.  In the absence of such evidence, it can not be said that the complainant failed to produce the required documents. Therefore, the abovecited judgment is not applicable to this complaint.

7)                The learned advocate for the O.P.No.1 has placed reliance on the judgment of Hon’ble National Commission in Original Petition No.137 of 1993, in the case of M/s. Zenith Computers Limited & Anr. –Versus- The New India Assurance Company Limited decided on 13^th December, 1994. In para 4 of the judgment, the Hon’ble National Commission has laid down as under :

Para 4 : It has been repeatedly held by this Commission that when an Insurance Company after duly considering a claim and applying its mind to all relevant aspects in good faith objects the claim, then it cannot be held guilty of deficiency or negligence in the rendering of service.  Consequently, we dismiss the present Complaint Petition.  The complainants may pursue their remedy in a civil court, if so advised.  This order will not affect their rights for seeking remedy in an appropriate Forum. 

In that judgment detailed reasons were given for repudiating the claim.  In the instant complaint before us, there is nothing on record to show that the complainant was informed to submit required documents. In fact, as per Government Resolution, it is the liability of the government office to submit all the necessary documents. On their failure, the complainant who is the beneficiary should not be suffered.  Therefore, the abovecited judgment is not applicable in this case. Similar view is taken in other judgment of the Hon’ble National Commission reported in 1986-96 National Commission and SC page 3060 in the case of B.L.Agarwal –Versus- National Insurance Company Limited decided on 21^st October, 1993.

8)                The learned advocate for the complainant has placed reliance on the judgment of our State Commission reported in 2008(2) All MR (Journal) 13 in the case of ICICI Lombard General Insurance Company Limited –Versus- Smt.Sindhubai Khanderao Khairnar, decided on 7^th January, 2008. In para 9 of the judgment, the Hon’ble State Commission has observed as under :

The Government declares various benevolent schemes for Agriculturists and person coming from lower strata of society. For effective implementation of the claim, Govt. prescribed simple procedure. Taking into consideration, the illiteracy in the rural areas, the liability is imposed on the Village Revenue Officer and Tahsildar for purpose of collection of necessary documents and submission of the claim to the insurance company. The success of benevolent scheme depends as to how and in what manner such schemes are implemented. Unfortunately, because of lukewarm and obstructive attitude of insurance company, genuine and honest claim of widow is defeated for no fault of her.

In the instant complaint before us also, claim form was immediately submitted to the government officer. Therefore, the claim of the complainant can not be repudiated. 

9)                It is submitted by the learned advocate for opponent that the deceased was not having valid driving license therefore he is not entitled for the benefit of this scheme.  For this purpose, he has placed reliance on the judgment of Hon’ble Supreme Court reported in (2008) 2 Supreme Court Cases 338.  This judgment is under Motor Vehicle Act.  The Scheme of Shetkari Apghat Vima Yojana is a special scheme which is beneficial to the farmers.  Therefore, the above cited judgment is not applicable here.  The learned advocate for the complainant has submitted that there was no fault of deceased in the accident.  Therefore, driving license is not required.  For this purpose, he has placed reliance on the judgment of our State Commission in the case of ICICI Lombard General Insurance Company Limited –Versus- Smt.Sindhubai Khanderao Khairnar in First Appeal No.1009/2007 dated 7^th January, 2008 reported in 2008(2) All MR (Journal) 13.  In para 8 of the judgment, the Hon’ble State Commission has held as under :

The Insurance Company insisted for driving license.  In fact, driving license is not necessary. From the perusal of the F.I.R., it is revealed that one Hundai car gave dash to the motor cycle from behind, which was being driven by the deceased.  In the said accident Shri Khanderao Krishna Khairnar sustained serious head injury and ultimately succumbed to the head injury in civil hospital on 7^th June, 2005. He was not at the fault.  He did not attribute for the commission of an accident. Therefore, driving license is not at all necessary to settle the insurance claim. In case of an accident on the road, information report, spot panchanama, inquiry report and post-mortem report are required as per the scheme.  In fact, these documents were submitted to the Insurance Company.  There is nothing on record to show that the deceased was under influence of any intoxication. Shri Khanderao Krishna Khairnar died because of head injury sustained in the road accident. Therefore, as per the scheme, widow of the deceased was one of the complainants. Widow stands at Serial No.1 in the list of claimants. 

In the instant complaint before us also as per police investigation papers, accident took place due to the fault of the driver of the Truck and not of the deceased.  Therefore, the submission of the learned advocate for the opponent can not be accepted.                   

10)              It is submitted by the learned advocate for the O.P.No.1 that the Post Mortem Report was not submitted therefore the complainant is not entitled for the claim.  According to the complainant, after the accident, the deceased was admitted in the hospital and he died in the hospital while taking treatment.  The complainant has produced Discharge Report of the hospital showing that the deceased died due to accidental injuries while taking treatment.  This Discharge Report is sufficient to prove that the deceased died due to injuries in the motor vehicle accident. Therefore, the submission made by the learned advocate for the O.P.No.1 can not be accepted.

11)              Thus, there is sufficient evidence on record to show that the deceased was the farmer holding agricultural land. He died accidentally in the motor vehicle accident.  The complainant is a widow therefore, as per the Agreement, the opponent is liable to satisfy the claim of the complainant. The complainant has complied all the formalities as required under the Agreement and the Government Resolution.

         As discussed above, the complainant is entitled for the relief as prayed. Hence, we proceed to pass the following order.

ORDER

1. Complaint is allowed.
2. The O.P.No.1/Insurance Company is directed to pay Rs.1,00,000/- (Rs.One Lakh Only) to the complainant with interest at the rate of 12% per annum from the date of death of the insured i.e. 10^th August, 2012  till its realization.
3. The O.P.No.1/Insurance Company is further directed to pay Rs.3,000/- (Rs.Three Thousand Only) to the complainant as cost of this proceeding.
4. The above order shall be complied with within a period of one month from today.
5. Copies of this order be sent to the parties free of cost.

Dictated & Pronounced on 2^nd March, 2015